New Customer Registration Form
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
How did you hear about us?
*
Please Select
Newspaper
Internet
Magazine
Other
Please Specify
*
What pets do you currently have at home?:
Have you ever had a Standard Poodle before?:
Will you be willing to recommend us?
Yes
No
Maybe
Please give reference of any two people to confirm positive pet ownership:
Full Name
Address
Contact Number
1
2
How will you ensure your puppy has adequate exercise and mental stimulation?:
Submit
Should be Empty: